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What now for reproductive health after Trump reinstates global gag rule?

The health sector in developing nations is in disarray after the Trump administration reinstated a policy that bans the distribution of US foreign aid to organisations that are involved in abortion-related activities, no matter how minimal that involvement is.

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It all started on 23 January when United States President, Donald Trump, signed an executive order, reinstating the Mexico City Policy also known by reproductive health organisations as the global gag rule.

The global gag rule is a US government policy that blocks US federal funding for non-governmental organisations that provide abortion counselling or referrals, or organisations that work to decriminalise abortion, or to organisations that offer abortion services.

US: world's largest foreign aid donor

The policy was first introduced in 1984 under Republican president Ronald Reagan, and has had a chequered history. It is regularly rescinded when Democrats enter the White House and reinstated when the Republicans get back in.

The government of the United States is the largest aid donor in the world. It distributes 43 billion US dollars – roughly the GDP of Tunisia - in foreign aid every year, with 9.5 billion US dollars channelled into overseas NGOs focused on health issues.

As a result, many organisations operating in developing countries rely heavily on funds from USAID, the United States Agency for International Development.

With the reintroduction of the global gag rule they will have to completely avoid any activity related to abortion if they want to keep receiving funds.

Tewodros Melesse is the director general of International Planned Parenthood Federation (IPPF). Founded in 1952
the IPPF is a global non-governmental organisation that promotes sexual and reproductive health, and advocates the right of individuals to make their own choices in family planning. Its an organisation which operates in 170 countries.

“America is telling other countries they don’t have the right to talk about abortion, [that] they don’t have the sovereign right to raise issues which are related to the health and empowerment of women,” he said.

“This one [administration] is telling us, that even if it is with our own money, even if it comes other sources, even if it is within the laws of a given country, that you cannot talk about abortion. That is unbelievable.”

This global gag rule doesn’t only affect family planning services. NGOs working on other health programmes, like HIV, Aids, malaria or Zika virus, also risk losing all US funds if they so much as mention abortion in their programmes.

The Mozambican Association for Family Planning (AMODEFA) gets 60 per cent of its funds from USAID. The global gag rule is will result in it having to suppress one its HIV Aids prevention programmes.

So, teenagers engage in sexual activitiy without knowing that they may carry the virus and potentially infect others.

Another problem is that many governments, relying on US funding, have already budgeted their health programmes for the year. Now they are faced with a financial gap they do not know how to cover and have to simply shut down some of their services.

Dutch minister Ploumen (R) visiting a school in Bangladesh where boys and girls follow sexual education together

Can #SheDecides help?

On 24 January, the day after President Trump signed his executive order, Liliane Ploumen, the Dutch minister for Foreign Trade and Development Cooperation, launched a fundraising initiative called She Decides to cover the financial shortfall.

“Worldwide 225 million women and girls would like to have access to information and contraceptives, to be the masters of their own body, and to make their own decisions. Now, with this executive order that President Trump signed millions of women and girls will suffer because of the lack of access to information and contraceptives.” she says.

On March 2nd - five weeks into the fundraising campaign 181 million euros was raised at the #SheDecides conference in Brussels.

The conference was also organised with Ploumen’s counterparts in Belgium, Denmark and Sweden. It managed to attract 450 participants from 50 countries in just 3 weeks.

Isabella Lövin is Sweden’s deputy prime minister and minister for international development cooperation and climate. “The issue of access to contraceptives and safe and legal abortion is a matter of life and death for millions of women. We’ve seen the progress made in the world in the last 25 years. Maternal mortality has gone down by almost half due to access to contraceptives and information about family planning,” she says.

“This is a positive development in the world that we can’t afford to reverse” Lövin adds. Her country ranks among the largest aid donors in the world.

Adama Dicko is the chairwoman of the Youth Action Movement in Mali. Over the past two years, she has worked with the USAID on a 600 thousand dollar programme to fund mobile clinics and a family planning campaign. It has now been cancelled because her NGO refused to abide by the gag rule and sign the new American clause.

“Unsafe abortion is a curse in Mali and there is hardly any family spared,” she said.

“In our society, a young girl who becomes pregnant and is not married is not only cast aside by her milieu but also by her friends and family. So, she would rather undergo an unsafe abortion procedure and risk death.”

A regression in family planning services is likely to result in unwanted teenage pregnancies which in turns mean being out of school and, consequently, poor employment prospects.

“Two million girls get pregnant before the age of fifteen every year across the world. And then she will of course quit school and she will not have an education, she will not have the maturity to give her children a proper upbringing that gives them the possibility for a better life. So, you’re replicating poverty in fact,” Lövin adds.

Replacing USAID

The She Decides movement has gained momentum in its endeavour to help NGOs across the world whose funding is now under threat.

However, it is unclear how the money will be distributed and what the criteria for distribution will be?

Amos Mwale is the executive director of the Centre for Reproductive Health and Education in Zambia:

“We should expect a race in terms of accessing funds provided by non US traditional donors, especially the Nordic countries and the UK government. We will also see a number of small, local organisations closing because they will not have funds to continue with their programming,” he says.

Mwale fears international NGOs like IPPF or Marie Stopes International will be given priority as they already enjoy a good reputation for the work carried out in various countries.

Almost all of the health workers who travelled to Brussels for the She Decides conference said they will not sign the new clause the American government is now imposing in order to be eligible receive health funding.

“It’s going to be challenging but we are not going to be defeated. And we are not going to sign that clause just to get the money because a woman’s right, a woman’s life cannot be transacted by money,” says IPPF’s Tewodros Melesse.